DEADLY PLURALISM? WHY DEATH‐CONCEPT,DEATH‐DEFINITION,DEATH‐CRITERION AND DEATH‐TEST PLURALISM SHOULD BE ALLOWED,EVEN THOUGH IT CREATES SOME PROBLEMS

Death concept, death definition, death criterion and death test pluralism has been described by some as a problematic approach. Others have claimed it to be a promising way forward within modern pluralistic societies. This article describes the New Jersey Death Definition Law and the Japanese Transplantation Law. Both of these laws allow for more than one death concept within a single legal system. The article discusses a philosophical basis for these laws starting from John Rawls' understanding of comprehensive doctrines, reasonable pluralism and overlapping consensus. It argues for the view that a certain legal pluralism in areas of disputed metaphysical, philosophical and/or religious questions should be allowed, as long as the disputed questions concern the individual and the resulting policy, law or acts based on the policy/law, do not harm the lives of other individuals to an intolerable extent. However, while this death concept, death definition, death criterion and death test pluralism solves some problems, it creates others.     

ARGUMENTS AGAINST PROMOTING ORGAN TRANSPLANTS FROM BRAIN‐DEAD DONORS,AND VIEWS OF CONTEMPORARY JAPANESE ON LIFE AND DEATH

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain‐death determination and organ extraction, and the appropriateness of priority transplants for relatives. In the four months of deliberations in the National Diet before the new law was established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain‐dead donors are unacceptable because they result in organs being taken from living human beings. Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain‐dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain‐dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply‐rooted views on life and death upon which it is based.     

BRAIN DEATH IN ISLAMIC ETHICO‐LEGAL DELIBERATION: CHALLENGES FOR APPLIED ISLAMIC BIOETHICS

Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico‐legal opinions on brain death. These assessments have varied in their determinations and remain controversial. Some juridical councils such as the Organization of Islamic Conferences' Islamic Fiqh Academy (OIC‐IFA) equate brain death with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize brain death to an intermediate state between life and death. Still other councils have repudiated the notion entirely. Similarly, the ethico‐legal assessments are not uniform in their acceptance of brain‐stem or whole‐brain criteria for death, and consequently their conceptualizations of, brain death. Within the medical literature, and in the statements of Muslim medical professional societies, brain death has been viewed as sanctioned by Islamic law with experts citing the aforementioned rulings. Furthermore, health policies around organ transplantation and end‐of‐life care within the Muslim world have been crafted with consideration of these representative religious determinations made by transnational, legally‐inclusive, and multidisciplinary councils. The determinations of these councils also have bearing upon Muslim clinicians and patients who encounter the challenges of brain death at the bedside. For those searching for ‘Islamically‐sanctioned’ responses that can inform their practice, both the OIC‐IFA and IOMS verdicts have palpable gaps in their assessments and remain clinically ambiguous. In this paper we analyze these verdicts from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists.     

弗氏柠檬酸杆菌对河触致病性的研究

首次报道了弗氏柠檬酸杆菌对河蟹的病原性、并导致其病理变化,药对物该菌的敏感试验及生产中药物治疗效果。从垂死的病蟹肝胰脏中分离得到可疑病菌,经人工感染试验证实此菌导致健康蟹发病死亡。该菌可导致河触的肝胰腺、鳃等发生病理变化,最终引起败血症而死亡。通过16种药物对该菌的敏感试验,筛选出有效药物,应用于生产中取得了较好疗效。     

Dealing With Death in the Jewish Legal Tradition

The main theme of the article is the tension between the obligation to preserve life, and the value of timely death. This tension is resolved by distinguishing between precipitating death, which is prohibited, and merely removing an impediment to it, which is permitted. In contemporary Jewish law, a distinction is made between therapy, which may be discontinued, and life-support, which must be maintained until the establishment of death. Another theme is that of “soft” patient autonomy, and its role in dealing with the dying in both traditional Jewish law and Israel’s Terminal Patient Law, 2005. Preventing suffering in relation to a dying person, and praying for his or her death are also discussed in the article.     

Assessment of platelet function in patients with stroke using multiple electrode platelet aggregometry: a prospective observational study

The Qatari law, as in many other countries, uses brain death as the main criteria for organ donation and cessation of medical support. By contrast, most of the public in Qatar do not agree with the limitation or withdrawal of medical care until the time of cardiac death. The current study aims to examine the duration of somatic survival after brain death, organ donation rate in brain-dead patients as well as review the underlying etiologies and level of support provided in the state of Qatar. This is a retrospective study of all patients diagnosed with brain death over a 10-year period conducted at the largest tertiary center in Qatar (Hamad General Hospital). Among the 53 patients who were diagnosed with brain death during the study period, the median and mean somatic survivals of brain-dead patients in the current study were 3 and 4.5 days respectively. The most common etiology was intracranial hemorrhage (45.3%) followed by ischemic stroke (17%). Ischemic stroke patients had a median survival of 11 days. Organ donation was accepted by only two families (6.6%) of the 30 brain dead patients deemed suitable for organ donation. The average somatic survival of brain-dead patients is less than one week irrespective of supportive measures provided. Organ donation rate was extremely low among brain-dead patients in Qatar. Improved public education may lead to significant improvement in resource utilization as well as organ transplant donors and should be a major target area of future health care policies.     

"Natural cause of death or not?" How do nursing home physicians act when in doubt of natural cause of death?

The objective of the study was to explore if nursing home physicians act by law, when they doubt the natural cause of death. In May 1999, a questionnaire was sent to 153 nursing home physicians in the region of Utrecht and Nijmegen. They were asked if they consult the coroner when they have doubts about the natural cause of death. Eighty-six percent (104) returned the questionnaire. Thirty-two percent of the nursing home physicians always consult the coroner and 52% does so most of the time. Only 12% does not consult the coroner most of the time and 2% never does. The main reasons for not consulting the coroner were that nursing home physicians judge a death after a fall as an incident that fits in the descending lifeline of patients and that some nursing home physicians had bad experiences consulting the coroner. We conclude that this policy may lead to underregistration of unnatural deaths. Changing the definition or changing the law may reduce this problem. Education and information can also contribute to change in physician's attitudes.     

我国涉天鹅属鸟类死亡案件分析及防控对策研究

我国有分布的天鹅属所有种(Cygnusspp.)均为国家Ⅱ级重点保护野生动物,根据中华人民共和国刑法,非法猎捕、杀害珍贵濒危野生动物构成刑事犯罪。然而,天鹅死亡案件仍时有发生。本文分析2000至2016年有统计的我国天鹅死亡案件发现,每年11月至翌年1月是涉天鹅案件的高发时期;毒杀为致死主因;案件多发生于我国行政区划交界处。因此,应于迁徙越冬季节重点加强高案发地点的侦查监管;加强克百威(呋喃丹)为代表的高毒农药管控;建立迁徙季节多地区执法联动机制。     

Adaptive Control Based Harvesting Strategy for a Predator–Prey Dynamical System

This paper deals with designing a harvesting control strategy for a predator–prey dynamical system, with parametric uncertainties and exogenous disturbances. A feedback control law for the harvesting rate of the predator is formulated such that the population dynamics is asymptotically stabilized at a positive operating point, while maintaining a positive, steady state harvesting rate. The hierarchical block strict feedback structure of the dynamics is exploited in designing a backstepping control law, based on Lyapunov theory. In order to account for unknown parameters, an adaptive control strategy has been proposed in which the control law depends on an adaptive variable which tracks the unknown parameter. Further, a switching component has been incorporated to robustify the control performance against bounded disturbances. Proofs have been provided to show that the proposed adaptive control strategy ensures asymptotic stability of the dynamics at a desired operating point, as well as exact parameter learning in the disturbance-free case and learning with bounded error in the disturbance prone case. The dynamics, with uncertainty in the death rate of the predator, subjected to a bounded disturbance has been simulated with the proposed control strategy.     

High growth rate and substrate exhaustion results in rapid cell death and lysis in the thermophilic bacterium Geobacillus thermoleovorans

Batch cultures of the thermophilic bacterium Geobacillus thermoleovorans T80 attained extremely high-specific glucose utilization rates leading to high specific growth rates, followed by extensive cell death and lysis with the onset of substrate exhaustion. The dramatic decrease in live cell numbers, as determined by flow cytometry, was accompanied by the release of soluble protein. Once the growth phase reached the point of commitment to lysis created by the impending exhaustion of substrate, the addition of extra carbon substrate did not halt the rapid death rate and lysis, although, towards the end of the exponential growth phase, the substrate was utilized producing only a small additional biomass concentration as a result of the net effect of cell growth and death. This lytic phenomenon was observed when a range of different carbon substrates (glucose, pyruvate, acetate, n-hexadecane, nutrient broth), as well as ammonium (the nitrogen source) in the presence of excess carbon source, reached near exhaustion. The rate and extent of cell death and the ensuing lysis depend on the culture growth rate. Cultures batch grown with a lower initial substrate concentration, or at a lower temperature, or at lower dilution rates for continuous-flow cultures, exhibited a lower rate and extent of cell death and lysis. Batch re-culture of the persister cells resulted in a behavior identical to that of the original culture indicating that these cells were not genetically modified. The glucose utilization, cell growth and death rates were mathematically described based on Monod kinetics and estimated values of pertinent biokinetic constants are reported.     

人禽流感疾病流行病学特征及其防治措施

最近几年来,因禽流感病毒感染而死亡的患者逐年增多,人禽流感在世界各地的流行已给许多国家和地区造成了不同程度的经济损失。为了更好地防止该病毒在全世界大规模流行,研究者开始重视对禽流感病原学特性、临床症状、传播途径、治疗方法及预防措施等进行研究与总结。我们针对人禽流感的研究进展及其预防与控制措施做简要概述。     

中西医结合治疗毒蛇咬伤773例

目的：探讨中西医结合治疗各类型毒蛇咬伤的临床方法。方法根据１９６４－１９９８年收治各类型毒蛇咬伤患者７７３例的临床资料,分析中草药、西医综合对症治疗及灵活应用抗蛇毒血清的临床疗效。结果治愈７６５例,治愈率９９．０％;死亡８例,死亡率。结果治愈７６５例,治愈率９９．０％;死亡８例,死亡率１．０％。结论建立完善的抢救治疗队伍,采用中西医结合的综合性治疗方法,可明显提高临床治愈率。     

Natural and unnatural death: assessment of the manner of death by nursing home physicians and notification to the medical examiner

The assessment of the manner of death by physicians is often a problem due to unclear regulations on this point. By means of a questionnaire we investigated how 40 nursing home physicians assess the manner of death in 14 different hypothetic cases and whether the physicians should report the case to the medical examiner if confronted with similar cases in practice. Some cases of unnatural death would not be reported. Especially in cases of death after a collum fracture the law and medical practice diverge. The reasons to report or not to the medical examiner were also investigated. Death fitting in the 'descending line of life' was most mentioned.     

A simple derivation of the Gompertz law for human mortality

The Gompertz law of dependence of human mortality rate on age is derived from a simple model of death as a result of an exponentially rare escape of abnormal cells from immunological response.     

MORAL FICTIONS AND MEDICAL ETHICS

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life‐sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life‐sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life‐sustaining treatment in order to bring accepted end‐of‐life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end‐of‐life decisions is radically mistaken.     

Hormone changes in relation to the time of fetal death after prostaglandin-induced abortion

The changes in unconjugated estradiol-17β and estriol, progesterone and chorionic somatomammotropin (HCS) in peripheral plasma have been studied in 18 women at 30-minute intervals following intra-uterine prostaglandin E₂ administration for therapeutic termination of second trimester pregnancy. The hormonal changes were related to the time of fetal death detected by the disappearance of fetal heart pulsations. Prostaglandin E₂ was given by the intra-amniotic route with urea (5 patients) or with intravenous oxytocin (5 patients), or by the extra-amniotic route with intravenous oxytocin (8 patients). Fetal death occurred rapidly with intra-amniotic PGE₂, but usually at a late stage with extra-amniotic PGE₂. Three fetuses in the extra-amniotic group died at or just before abortion. A variety of fetal heart changes were noted and the time of fetal death did not appear to influence the time of abortion within each treatment subgroup.Estradiol and estriol showed a slight but persistent fall over 24 hours prior to induction of abortion. A more rapid fall usually occurred after induction, with a consistent fall around the time of fetal death. Progesterone and HCS usually fell much less before and immediately after fetal death. A marked rise in estradiol sometimes occurred before fetal death, particularly in the intra-amniotic PGE₂ and urea subgroup. Estriol levels declined more rapidly before than after fetal death, whereas fetal death had less consistent effects on the other hormones. All hormones had usually fallen considerably at the time of abortion, and in some individuals marked fluctuations in hormone levels were seen.     

Some legal implications of advances in human genetics.

The law which, to some extent at least, reflects contemporary mores, has not kept pace with the recent scientific advances in genetics. Because of the rate of advance in the science of genetics there is a real risk that we shall know how to change the traditional nature of man before we possess the knowledge necessary to enable us to use the new knowledge for humane purposes. Clonal reproduction may produce a creature who, for the purposes of the law, especially the criminal law, which defines when a child becomes a human being in terms of "old-fashioned" motherhood, may not be a human being, so that putting him to death may not be homicide. Similarly, in vitro fertilization and development in an artificial uterus may result in the "birth" of one who, though having human attributes, may not, in law, be a human being. While cloning and in vitro fertilization may not have immediate legal implications because of the state of the art, genetic manipulation in the form of amniocentesis has very real legal implications now because it is a matter of current practice. The assumption that detection of genetic abnormality in the foetus is a beneficial development because it enables parents to have the option of terminating the pregnancy, though valid in the United Kingdom and the United States, is invalid in Canada. Abortion on demand is not part of the law in Canada and the liberalization of the abortion provisions of the Criminal Code of Canada in 1969 expressly avoided including as a criterion for therapeutic abortion the risk that the child, if born, would be likely to suffer from such physical or mental abnormalities as to be seriously handicapped. Beyond the more technical issues raised by scientific advances, however, lies the fundamental question whether a handicapped life is a life not worth living.     

Death and Kinship in Hinduism: Structural and Functional Interpretations

This paper is, first, a structural analysis demonstrating that in Hindu sacred "law" death rites reflect a conception of kinship wherein intimacy is affected not only by such matters as genealogical distance, but also by differences in spiritual purity among kinsmen. Second, the paper shows that structural analysis of particular civilizations have more than intrinsic value, that they are also a necessary adjunct to highly general functional theories.     

Estimation of the thermal coefficient in the decline of a bacterial population under heat stress.

The "most probable number" (MPN) technique for estimating numbers of bacteria in suspensions is well known and has been used for decades by microbiologists, food researchers, and other laboratory scientists. A related procedure, involving an infinite number of serial dilutions at each of times ti, i = 0,1,...,n, is considered, and the joint probability law of the index numbers of the last tubes showing growth at these times is derived through use of probability-generating functions. Maximum likelihood estimates of the initial density lambda and the thermal death rate mu are computed. Another estimate, mu, of mu is given, using a simple weighting scheme. Finally, the thermal death time (TDT) is estimated by D = (1n 10)/mu.     

Knowing,Anticipating, Even Facilitating but Still not Intending: Another Challenge to Double Effect Reasoning

A recent administrative law decision in Victoria, Australia, applied double effect reasoning in a novel way. Double effect reasoning has hitherto been used to legitimate treatments which may shorten life but where the intent of treatment is pain relief. The situation reviewed by the Victorian tribunal went further, supporting actions where a doctor agrees to provide pentobarbitone (Nembutal) to a patient at some time in the future if the patient feels at that time that his pain is unbearable and he wants to end his life. The offer to provide the drug was described as a palliative treatment in that it gave reassurance and comfort to the patient. Double effect reasoning was extended in this instance to encompass potentially facilitating a patient’s death. This extension further muddies the murky double effect reasoning waters and creates another challenge to this concept.